Nevada facing lawsuit over busing of mentally ill patients

The state of Nevada and its primary psychiatric hospital violated the constitutional rights of mentally ill people by discharging them via Greyhound bus to cities across the nation without proper consent or making arrangements for their care, a lawsuit filed in U.S. District Court in Las Vegas charges.

The complaint, which seeks class-action status, names former Rawson-Neal patient James Flavy Coy Brown, 48, as its chief plaintiff. The Bee reported earlier this year that Rawson-Neal staff discharged Brown to a Greyhound bus bound for Sacramento without making arrangements for his treatment, housing or care.

Brown was admitted to Rawson-Neal's psychiatric observation unit in February with symptoms of psychosis, according to hospital records. He suffers from a range of mood disorders, including schizophrenia, and had been living in Las Vegas shelters for years.

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He told The Bee that a Rawson-Neal physician told him that Nevada had no place for him. "Pick a state," he said the doctor told him. "How about sunny California?"

After 72 hours, he was discharged to Sacramento, a city he had never visited. He arrived at the Sacramento bus depot suicidal and confused, having emptied his three-day supply of medications and liquid Ensure.

He ultimately landed in the emergency room at UC Davis Medical Center, where he lingered days before gaining admission to a private psychiatric hospital and later a boarding home in Sacramento. He has since been reunited with his daughter in North Carolina.

Merin said as many as 100 other former Rawson-Neal patients could join the suit.

Named as defendants are Rawson-Neal and three staff members; Southern Nevada Adult Mental Health Services, the state agency that oversees the hospital; and other Nevada agencies.

Mary Woods, spokeswoman for the Nevada Department of Health and Human Services, said state officials had not seen the lawsuit as of Tuesday afternoon and declined to comment.

The suit also claims the hospital violated the constitutional right to equal protection by shipping indigent patients out of state, while "retaining or arranging appropriate discharge" for those who could pay for services. It asks for unspecified damages.

Patients "were transported out of the State of Nevada and then 'dumped' into cities and states with which they had little or no prior contacts and where no one was present to receive or to care for them ," the lawsuit reads.

"They were administered powerful psychotropic medication and, while unable intelligently or knowingly to consent, were placed into taxis, and conveyed to Greyhound buses ."

After Brown's story surfaced, The Bee reviewed Greyhound bus receipts purchased by Southern Nevada Adult Mental Health Services for Rawson-Neal patients. That review found the hospital had bused roughly 1,500 patients to states across the nation over the past five years, a third of them to California.

Since mid-2008, as the state cut mental health spending, the number of psychiatric patients getting one-way tickets out of Rawson-Neal steadily rose, according to The Bee's review. By last year, Rawson-Neal was busing patients out of Las Vegas at a pace of more than one per day, shipping nearly 400 patients to 176 cities in 45 states.

In the months since The Bee published its findings, Nevada health officials have both revised and largely defended the unusual busing practice, saying Las Vegas is an international destination that attracts more than its share of visitors.

They have admitted that they "blew it" by sending Brown to Sacramento but maintain that the vast majority of patients transported out of state were being sent to their "home communities," where they had support systems or family to meet them.

Nevertheless, Nevada health officials revised the policy in April, announcing that the hospital no longer would bus patients to other states without a chaperone. Two staff members were fired and others disciplined in connection with Brown's case.

Two outside consultants hired by the state to review patient care at Rawson-Neal defended the busing policy in a report released last month. While the consultants found that some patients may have been discharged improperly, they wrote that the policy was often humane.

"In many cases," wrote Drs. Ken Appelbaum and Joel Dvoskin, "helping people to get home safely is a kindness to them and to their families."

But Allen Lichtenstein, general counsel of the ACLU of Nevada, said busing patients to other states without proper consent and treatment represents a clear violation of civil rights. The agency joined the suit to "ensure that this type of thing never happens again," he said.

The suit asks the court to certify Brown and other patients as a legal "class," to prevent the hospital from busing patients who are mentally unable to give their consent, and to ensure that proper arrangements are made for care at their destinations.

Merin said he has spoken with several former patients who had experiences similar to Brown's, including a mentally ill woman who was bused from Las Vegas to Michigan, where she has no relatives. The woman is "in bad shape, in and out of institutions and halfway houses" in that state, Merin said.

Lawyers are interviewing the woman and other former patients in a "due diligence" effort to confirm their stories, and are looking for others who believe they were mistreated, Merin said. The process is difficult, he said, because patient names and medical records cannot be disclosed without their permission. Some former patients are homeless and difficult to track, he said. But "we are certain that this was not just Mr. Brown's problem," Merin said. "Many others experienced the same things."

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